Workshop Registration

Child's name *

Child's age *

2

3

4

5

Parent or Caregiver Name *

Parent or Caregiver Phone Number *

The parent or caregiver authorizes for their child’s photo/video to be taken and used for promotional purposes on Ava Mia Playroom social media.
*

Yes

No

Please, read the "Waiver and Release of Liability" and check the box *

I, the parent / caregiver, understand and agree to the waiver and release of liability Agreement

Required

Please, choose your *

Yes

Required